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81 terms

PT mgmt for vestibular/balance dys.

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CNS compensation
With the exception of BPPV, vestibular rehab exercises are designed to promote what?
rotational vertigo
illusion of self-motion or object motion
positional vertigo
vertigo/dizziness precipitated by changes in head position
vestibular vertigo
rotational vertigo, positional vertigo, or recurrent dizziness with nausea and oscillopsia or imbalance
females
is vertigo more common in males or females?
older
is vertigo more common in older or younger adults?
unilateral vestibular loss
loss or diminished function of one peripheral vestibular system
labyrinthitis
UVL diagnosis characterized by: sudden or gradual onset of hearing loss, severe vertigo, nausea/vomiting. Symptoms plateau in approx. 24 hours, and last 3-4 days. Gradually recovery over 5-7 weeks.
vestibular neuritis
UVL diagnosis characterized by: acute onset of severe rotatory vertigo, spontaneous nystagmus, postural imbalance, nausea/vomiting. Recovery gradual over 48-72 hours, with gradual return of balance over 6 weeks.
fluctuating hearing loss, tinnitus, episodic attacks of vertigo
What is the triad of symptoms associated with Meniere's disease?
Meniere's Disease
UVL diagnosis caused by a decrease in endolymph re-absorption, resulting in an accumulation of fluid in the compartment which leads to rupture, causing paralysis of the vestibular/auditory mechanisms.
salt, water, alcohol, caffeine, nicotine
General dietary restrictions for the treatment of Meniere's disease include the restriction of what (5)?
diuretics
What general type of medication is prescribed for the treatment of Meniere's disease?
no
Are vestibular exercises appropriate for most cases of Meniere's disease?
vestibular
Section of what nerve has a 90-95% success rate for treating Meniere's disease?
Acoustic neuroma
nerve sheath tumor usually found in the internal auditory canal or cerebellopontine angle
progressive unilateral SNHL
The primary complaint with an acoustic neuroma is the insidious onset of what?
watchful waiting, radiosurgery, surgical removal
What are the three therapeutic options for treating acoustic neuroma?
perilymph fistula
An opening between the inner and middle ear through the round or oval windows, perilymph leaks into the middle ear space, which causes vestibular symptoms.
aminoglycosides
one major cause of Bilateral vestibular loss is ototoxicity caused by exposure to what group of antibiotics?
aminoglycosides
streptomycin, gentamicin, amikacin, tobramycin, netilmicin are all examples of what?
ototoxicity
oscillopsia, ataxia, nausea/vomiting, light headedness or episodic vertigo, tinnitus, or inabililty to walk in the dark or read while walking are all signs and symptoms of what?
dysequilibrium, oscillopsia, hearing loss/vertigo
What are three primary symptoms reported by patients with ototoxicity?
fall
patients with BVL are more likely to do what, compared to normal subjects their age or patients with UVL?
no
In a patient with BVL, will position and movement tests provoke vertigo?
decreased
What happens to static standing balance in patients with BVL?
dynamic posturography
Type of test that is used to determine which system a person relies on to maintain balance (vestibular, vision, somatosensory)
visual
Research has shown that patients with BVL are initially more dependent on which system for maintaining standing balance?
ataxic
The gait pattern of a patient with BVL is usually what?
Dynamic gait index
Measure used to assess the ability to modify gait during changes in task performance for individuals with balance impairments i.e. BVL.
gaze and postural stability
Vestibular rehab focuses on the recovery of what?
saccadic, smooth pursuit
In order to compensate for the loss in VOR function, exercises used to treat patients with BVL are used to foster the substitution of what eye movements?
vertigo
The illusion of motion of self or the environment
dizziness
lightheadedness or feeling like you are going to pass out. Generalized weakness/blurred vision.
dysequilibrium
Feeling of "bad balance" experienced while standing or walking.
peripheral
symptoms that are worse in the AM and better in the PM may indicate which type of vestibular problem (peripheral or central)?
central
Symptoms that are better in the AM and worse in the PM may indicate which type of vestibular problem (peripheral or central)?
Dizziness handicap inventory
self assessment inventory designed to evaluate physical and emotional factors associated with dizziness and vestibular system disease.
vestibular suppressants
Antihistamines, benzodiazepines, and anticholinergic drugs are all examples of what?
dizziness handicap inventory
What is the best tool to determine if a patient has BPPV?
vestibular
class of eye movement that holds images steady on the retina during brief head rotations
optokinetic
class of eye movement that holds images steady during sustained head rotation
smooth pursuit
class of eye movement that holds the image of a small moving target on the fovea
saccade
class of eye movement that brings images of objects of interest onto the fovea
visual fixation
class of eye movement that holds the image of a stationary object on the fovea
mechanoreceptors
vestibulo-ocular reflexes rely on labyrinthine ___________ to sense head accelerations
vestibulo-ocular, visually mediated
What 2 reflexes help stabilize gaze?
saccadic
Which eye system is responsible for shifting gaze?
saccade
Which eye system generates a high-velocity ballistic movement to scan the environment?
pursuit
Which eye system maintains a target in motion on the fovea while the head remains stationary?
vestibulo-ocular
Which eye system maintains a stable gaze with head movements?
VOR
What is the primary mechanism for gaze stability?
angular
Which component of the VOR is mediated by the SCCs and activated by head movements in any direction?
Linear
which component of the VOR is mediated by the otoliths and activated by high frequency head movements when near targets are being viewed?
brainstem and cerebellum
Gaze-evoked vertical nystagmus suggests lesions affecting what areas of the brain?
peripheral
If nystagmus stabilizes with fixation, it is of what origin?
central
If nystagmus does not stabilize with fixation, it is of what origin?
low
A person with damage to the pursuit system will most likely have _____ gain.
nystagmus
repetitive, tremor-like oscillating movement of the eyes
quick phase
Nystagmus is named by the direction of what?
away from
In peripheral vestibular nystagmus (mixed horizontal-torsional trajectory), the quick phase usually beats _________ the side of the lesion.
vestibular nuclear or cerebellar vermis
Vertical nystagmus is 80% sensitive for what types of lesions?
primary
In what eye position is spontaneous nystagmus observed?
gaze evoked
type of nystagmus observed during the test of smooth pursuit eye movements.
30
Gaze evoked nystagmus occurs when the eyes are ____ degrees eccentric
sensorineural, conductive, mixed
What are the three types of hearing loss?
sensorineural
What is the most common form of hearing loss (90% of cases).
middle
conductive hearing loss is caused by a problem in what area of the ear?
air
Is the inner ear more sensitive to sound conducted by air or bone?
bone
In a pure conductive loss, is the affected ear more sensitive to air or bone conducted sound?
512 hz
What is the frequency of the tuning fork that is most commonly used to test for hearing loss?
Rinne
Which test firsts test air conduction by holding the tuning fork outside the external auditory meatus, then tests bone conduction by holding the tuning fork on the base of the mastoid process?
bone
In a negative Rinne test indicating conductive loss, which would be louder, Air conduction or bone conduction?
Weber
Which test places the tuning fork at midline on the forehead, and asks the patient if they can hear the sound equally in both ears or better in one ear?
right
If a person has a conductive hearing loss on the right side, which side will they perceive the sound in the Weber test?
balance
the ability to conrol the body's center of mass relative to the limits of stability associated with a specific task and to the environment in ahiwhc it is preformed
limit of stability
maximum anterior, posterior and lateral distance from center while maintaining the center of gravity within the base of support.
12, 16
The limit of stability should be approximately ____ degrees front to back, and ____ degrees side to side.
center of gravity
An imaginary point in space about which the sum of the forces and moments equals zero
ankle, hip, stepping
What are the 3 normal balance strategies?
distal to proximal
The normal sequencing of balance strategies generally moves in what direction?